Buckland AJ, et al. - A multi-center database of preoperative 1,088 THA individuals was examined by the experts in order to ascertain the prevalence of sagittal spinal deformity (SSD) among preoperative THA individuals. About 59%, 16% and 4% of individuals had balanced alignment, a pelvic incidence (PI)-lumbar lordosis > 10°, and a PI-LL > 20°. Hyperlordosis had the prevalence of 25% (n = 270). Flatback individuals were elderly than balanced and hyperlordotic individuals. The spinopelvic tilt was more posterior in flatback when compared wth balanced and hyperlordotic individuals and so was pelvic plane tilt and PI. In conclusion, just 59% of individuals who underwent THA had normally-aligned lumbar spines. Flatback SSD was noted in 16% with a 25% prevalence of hyperlordosis. Lumbar flatback was related to advancing age, posterior pelvic tilt and greater PI. The relatively high prevalence of spinal deformity in this population reinforced the significance of acknowledging spinopelvic alignment in THA planning and risk stratification.